Alternative diagnosis

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Alternative diagnosis

Postby StrongMom » Fri May 18, 2012 07:15 am

I was recently told that the alternative method for IDing pree with 15-20 points above your baseline bp has been disproven and should not be used for a diagnosis. My question is does anyone have any information on this? Or has anyone been diagnosed via this method but didn't hit the 140/90 mark but definitely had preeclampsia or was diagnosed via this method but feels that the diagnosis was inaccurate? TIA
DS born 2010 at 37 week 5 lbs 13 oz due to pre-e
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Re: Alternative diagnosis

Postby alviarin » Fri May 18, 2012 02:48 pm

The diagnostic criteria for preeclampsia is still at least 300 mg proteinura in a 24 hour urine test plus two high BP readings at least six hours apart (140/90 or above, either number).

However, our experts have said any significant increase in pressures (30/15) above normal non-pregnant baseline is of concern and warrants closer monitoring. We had at least one poster who progressed to eclampsia without pressures quite getting to the research cut-off of 140/90, with a low non-pregnant baseline. And it is possible (but rare) to get HELLP syndrome without having high pressures, but HELLP is usually diagnosed on the basis of bad bloodwork results. We have also had posters still dx'd with pre-e who didn't have time to do a 24 hour urine, since their condition was deteriorating rapidly.

I hope this helped answer your questions.
Hypothyroid mom to Connor and Claire
(severe pre-e at 38 weeks & "mild" pre-e at 37 weeks)
& baby Annabelle
(chronic HTN & GD, superimposed pre-e @34 weeks, induction @37 weeks)
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Re: Alternative diagnosis

Postby StrongMom » Tue May 22, 2012 09:52 am

Which makes sense to me.... could not believe not having a significant increase in your baseline even if it doesn't reach the magical 140/90 *has been proven* to not be preeclampsia/eclampsia. Obviously the the more traditional diagnosis would make sense for the majority of the population. This was coming from someone who is a medical professional who works in L&D.

How does this work for pre-hypertensives then, (120-130/80-89) range? They can only increase 1 point in some cases? I was just hoping to find some more information on whether or not this had been totally ruled out as part of the diagnostic criteria and how they handle someone with very low bp to start as well (90/60) who now has bps in the 120/80s range and is spilling protein- but isn't considered preeclamptic because she hasn't reached 140/90? (This is coming from another message board I follow)
DS born 2010 at 37 week 5 lbs 13 oz due to pre-e
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Re: Alternative diagnosis

Postby angieb » Tue May 22, 2012 10:16 am

I had HELLP syndrome with my blood pressure never getting to or above 140/90.
Me (29) DH (30)
#1-Olivia Caetlyn-9-28-09-9-28-09, 23+2 wks, emergency classic c-section, class I HELLP, IUGR
#2- Lucas Oliver (rainbow baby)- April 2011, 36+2 wks, HELLP and pre-e free! (lovenox and LDA pregnancy)
#3-Matthew, late October 2012...mostly normal, 37 wks, (lovenox and LDA again)
My blog: http://www.butterflies-and-rainbows.blogspot.com/
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Re: Alternative diagnosis

Postby aajatwins » Tue May 22, 2012 03:13 pm

I had only creeping BPs during my twin pregnancy. At the beginning of induction, I was 135/85 (baseline 90/60) and when I spiked out at 150/105, I seized. I never spilled a bit of protein, so I have no idea where I fall in PIH/PE categories other than eclampsia.

On the other hand, my cousin's wife has chronic HTN and so has had PE with all 3 pregnancies. other than bedrest and BP meds, she has "normal" pregnancies and delivers full-term babies with no issues.

PE is just a crazy thing.
Anna (28) - endometriosis
Hubby (27)
Aidan & Jordan - 7.2.09 at 36 weeks. Induction turned emergency c-section due to eclampsia. big healthy toddlers today!
Asa - 10.23.11 at 39 weeks. NO hypertensive issues!! successful VBAC :)
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Re: Alternative diagnosis

Postby StrongMom » Tue May 22, 2012 04:31 pm

Did you know the pitocin can cause your bp to increase dramatically even without preeclampsia/eclampsia/PIH? And that can actually lead to many of the same things preeclampsia causes.
DS born 2010 at 37 week 5 lbs 13 oz due to pre-e
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Re: Alternative diagnosis

Postby alviarin » Tue May 22, 2012 04:35 pm

StrongMom wrote:W
How does this work for pre-hypertensives then, (120-130/80-89) range? They can only increase 1 point in some cases? I was just hoping to find some more information on whether or not this had been totally ruled out as part of the diagnostic criteria and how they handle someone with very low bp to start as well (90/60) who now has bps in the 120/80s range and is spilling protein- but isn't considered preeclamptic because she hasn't reached 140/90? (This is coming from another message board I follow)


Hopefully she is being watched closely by her doctors. And she know the signs and symptoms of pre-eclampsia. http://www.preeclampsia.org/health-info ... d-symptoms

If you go to our Care Providers page you will find links to some more technical guidelines, like ACOG Practice Guideline for Diagnosing and Managing Pre-eclampsia and Eclampsia: http://www.preeclampsia.org/care-providers

Although it is out-dated (though not inaccurate) the NIH working group report on High Blood Pressure in Pregnancy states:

"In the past it has been recommended that an increment of 30 mm Hg systolic or 15 mm Hg diastolic blood pressure be used as a diagnostic criterion, even when absolute values are below 140/90 mm Hg. This definition has not been included in our criteria because the only available evidence shows that women in this group are not likely to suffer increased adverse outcomes.14,15 Nonetheless, it is the collective clinical opinion of this panel that women who have a rise of 30 mm Hg systolic or 15 mm Hg diastolic blood pressure warrant close observation, especially if proteinuria and hyper- uricemia (uric acid [UA] greater than or equal to 6 mg/dL) are also present."
http://www.nhlbi.nih.gov/guidelines/archives/hbp_preg/

They are working on some diagnostic tests to ID women at risk earlier -before they are symptomatic- but they are still in research stages.
Hypothyroid mom to Connor and Claire
(severe pre-e at 38 weeks & "mild" pre-e at 37 weeks)
& baby Annabelle
(chronic HTN & GD, superimposed pre-e @34 weeks, induction @37 weeks)
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Re: Alternative diagnosis

Postby StrongMom » Tue May 22, 2012 06:21 pm

alviarin wrote:
StrongMom wrote:W
How does this work for pre-hypertensives then, (120-130/80-89) range? They can only increase 1 point in some cases? I was just hoping to find some more information on whether or not this had been totally ruled out as part of the diagnostic criteria and how they handle someone with very low bp to start as well (90/60) who now has bps in the 120/80s range and is spilling protein- but isn't considered preeclamptic because she hasn't reached 140/90? (This is coming from another message board I follow)


Hopefully she is being watched closely by her doctors. And she know the signs and symptoms of pre-eclampsia. http://www.preeclampsia.org/health-info ... d-symptoms

If you go to our Care Providers page you will find links to some more technical guidelines, like ACOG Practice Guideline for Diagnosing and Managing Pre-eclampsia and Eclampsia: http://www.preeclampsia.org/care-providers

Although it is out-dated (though not inaccurate) the NIH working group report on High Blood Pressure in Pregnancy states:

"In the past it has been recommended that an increment of 30 mm Hg systolic or 15 mm Hg diastolic blood pressure be used as a diagnostic criterion, even when absolute values are below 140/90 mm Hg. This definition has not been included in our criteria because the only available evidence shows that women in this group are not likely to suffer increased adverse outcomes.14,15 Nonetheless, it is the collective clinical opinion of this panel that women who have a rise of 30 mm Hg systolic or 15 mm Hg diastolic blood pressure warrant close observation, especially if proteinuria and hyper- uricemia (uric acid [UA] greater than or equal to 6 mg/dL) are also present."
http://www.nhlbi.nih.gov/guidelines/archives/hbp_preg/

They are working on some diagnostic tests to ID women at risk earlier -before they are symptomatic- but they are still in research stages.



Thank you!!! This is exactly what I was looking for.

I am very worried for this women, especially since she is spilling protein and has headaches. I have urged her to see an OB. However, her midwife wasn't concerned because her bp wasn't 140/90. Then a 'medical professional' jumped on the thread and also told her not to worry since the recommendation to worry about numbers increasing 30/15 points above baseline were outdated. She jumped on this not wanting to believe that anything was really wrong. Hopefully, she will seek help before anything goes dramatically wrong.
DS born 2010 at 37 week 5 lbs 13 oz due to pre-e
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Re: Alternative diagnosis

Postby alviarin » Tue May 22, 2012 06:32 pm

UKs 2005 PRECOG guidelines have some reccomendations for new-onset proteinura (even w/o hypertenstion:)
http://www.preeclampsia.org/images/pdf/ ... elines.pdf
Hypothyroid mom to Connor and Claire
(severe pre-e at 38 weeks & "mild" pre-e at 37 weeks)
& baby Annabelle
(chronic HTN & GD, superimposed pre-e @34 weeks, induction @37 weeks)
alviarin
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Re: Alternative diagnosis

Postby aajatwins » Wed May 23, 2012 10:09 pm

StrongMom wrote:Did you know the pitocin can cause your bp to increase dramatically even without preeclampsia/eclampsia/PIH? And that can actually lead to many of the same things preeclampsia causes.


I know all about it now :) I was never diagnosed with any hypertensive issues in that pregnancy, so I knew nothing about what pitocin could do then. I'm sure being hit with pitocin was not in my best interest at that time, but I had been having "the" headache for two days before that and had vision changes the night before - so I was already well on my way to poor situation. However, during my VBAC, the pitocin did nothing to my BP. (Actually, the epidural lowered it enough that they gave me something to raise it back up - talk about feeling like I needed to freak out.)
Anna (28) - endometriosis
Hubby (27)
Aidan & Jordan - 7.2.09 at 36 weeks. Induction turned emergency c-section due to eclampsia. big healthy toddlers today!
Asa - 10.23.11 at 39 weeks. NO hypertensive issues!! successful VBAC :)
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